Pregnant Muslims may be religiously exempt from fasting during the month of Ramadan if there is any concern for undue hardship or maternal or fetal harm. The current data on the effect of Ramadan fasting (RF) on maternal health outcomes show insufficient evidence of an association with hypertension and preeclampsia. There is conflicting data regarding the negative vs. protective association of RF on developing gestational diabetes mellitus (GDM) and glycemic control. Some evidence exists regarding changes in different hormone concentrations, lipid profiles, and ketonuria. There is no association with changes in uterine artery pulsatility indices. Some data suggest an association with signs and symptoms of maternal fatigue and dehydration, equivalent to lower mean maternal weight gain. There is conflicting data on mode of delivery. Data suggest a potential decrease in placental weight and possible effect on macronutrients of breast milk. The current data on the impact of RF on fetal health outcomes show some associations with impact on antenatal fetal testing indices, including nonstress tests (NSTs), lower amniotic fluid levels, and lower biophysical profile (BPP) scores. There is an increase or no difference in intrauterine growth indices in fasters. Little to no clinically significant effect on neonatal birthweight or preterm delivery has been found. There are possible adverse long-term effects on offspring of fasting mothers, but more data are required. The variation in defining “Ramadan fasting” in pregnancy and in study size and design breed many potential confounders and negatively impact the quality of the existing evidence. More research is needed to better understand the true effect of fasting during Ramadan on certain outcomes. Obstetric providers need to demonstrate cultural and religious awareness and confidently counsel their patients on the nuances of the literature while making individualized recommendations.